Hanneke Doremiek van Oorschot MD, Jose Angelito Hardillo MD, PhD, Robert J.J. van Es MD, DDS, PhD, Guido B. van den Broek MD, PhD, Robert Paul Takes MD, PhD, Gyorgy Bela Halmos MD, PhD, Dominique Valerie Clarence de Jel MD, Richard Dirven MD, PhD, Martin Lacko MD, PhD, Lauretta Anna Alexandra Vaassen MD, DDS, Jan-Jaap Hendrickx MD, PhD, Marjolijn Abigal Eva-Maria Oomens MD, DDS, Hossein Ghaeminia MD, DDS, PhD, Jeroen C. Jansen MD, PhD, Annemarie Vesseur MD, Rolf Bun MD, DDS, PhD, Leonora Q. Schwandt MD, PhD, Christiaan A. Krabbe MD, DDS, PhD, Thomas J.W. Klein Nulent MD, DDS, Reinoud J. Klijn MD, DDS, PhD, Alexander J.M. van Bemmel MD, Robert Jan Baatenburg de Jong MD, PhD
{"title":"Surgical Complications for Oral Cavity Cancer: Evaluating Hospital Performance","authors":"Hanneke Doremiek van Oorschot MD, Jose Angelito Hardillo MD, PhD, Robert J.J. van Es MD, DDS, PhD, Guido B. van den Broek MD, PhD, Robert Paul Takes MD, PhD, Gyorgy Bela Halmos MD, PhD, Dominique Valerie Clarence de Jel MD, Richard Dirven MD, PhD, Martin Lacko MD, PhD, Lauretta Anna Alexandra Vaassen MD, DDS, Jan-Jaap Hendrickx MD, PhD, Marjolijn Abigal Eva-Maria Oomens MD, DDS, Hossein Ghaeminia MD, DDS, PhD, Jeroen C. Jansen MD, PhD, Annemarie Vesseur MD, Rolf Bun MD, DDS, PhD, Leonora Q. Schwandt MD, PhD, Christiaan A. Krabbe MD, DDS, PhD, Thomas J.W. Klein Nulent MD, DDS, Reinoud J. Klijn MD, DDS, PhD, Alexander J.M. van Bemmel MD, Robert Jan Baatenburg de Jong MD, PhD","doi":"10.1002/lary.32033","DOIUrl":null,"url":null,"abstract":"<div>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>Complications of oral cavity cancer (OCC) surgery have an impact on the quality of life. Therefore, evaluating hospital performance on complication rates can help identify best practices for improving the quality of OCC care. As patient and tumor characteristics also impact hospital results, case-mix adjustment should be considered to provide a valid hospital comparison. This study investigated hospital variation in the quality indicator “a complicated postoperative course” after OCC surgery.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This population-based cohort included all first primary OCC patients diagnosed between 2018 and 2021 who were surgically treated with curative intent. A complicated postoperative course was defined as 30-day mortality, unplanned readmission, surgical complications requiring reintervention or prolonged hospital stay, or fistula formation. Hospital performance was analyzed using funnel plots with case-mix correction.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 2,266 OCC patients could be included. The distribution of case-mix variables varied significantly between hospital populations. Nationally, a complicated postoperative course occurred in 13.9% and uncorrected hospital rates ranged from 2.7% to 31.1%. A WHO performance score ≥2, cT3-T4 tumors, and floor-of-mouth tumors were associated with an increased risk of a complicated postoperative course, and non-squamous cell carcinoma with a decreased risk. Significant outliers remained after case-mix correction for patient, tumor, and treatment characteristics.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Complications after OCC surgery are prevalent, especially regarding extensive tumors and surgery. To identify best practices in OCC surgery, hospital performance on a complicated postoperative course should be adjusted for case-mix and treatment variables. Providing feedback on hospital performance for complications can instigate improvement plans for better outcomes.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>3 <i>Laryngoscope</i>, 135:2411–2419, 2025</p>\n </section>\n </div>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":"135 7","pages":"2411-2419"},"PeriodicalIF":2.0000,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lary.32033","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Laryngoscope","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/lary.32033","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
引用次数: 0
Abstract
Objective
Complications of oral cavity cancer (OCC) surgery have an impact on the quality of life. Therefore, evaluating hospital performance on complication rates can help identify best practices for improving the quality of OCC care. As patient and tumor characteristics also impact hospital results, case-mix adjustment should be considered to provide a valid hospital comparison. This study investigated hospital variation in the quality indicator “a complicated postoperative course” after OCC surgery.
Methods
This population-based cohort included all first primary OCC patients diagnosed between 2018 and 2021 who were surgically treated with curative intent. A complicated postoperative course was defined as 30-day mortality, unplanned readmission, surgical complications requiring reintervention or prolonged hospital stay, or fistula formation. Hospital performance was analyzed using funnel plots with case-mix correction.
Results
A total of 2,266 OCC patients could be included. The distribution of case-mix variables varied significantly between hospital populations. Nationally, a complicated postoperative course occurred in 13.9% and uncorrected hospital rates ranged from 2.7% to 31.1%. A WHO performance score ≥2, cT3-T4 tumors, and floor-of-mouth tumors were associated with an increased risk of a complicated postoperative course, and non-squamous cell carcinoma with a decreased risk. Significant outliers remained after case-mix correction for patient, tumor, and treatment characteristics.
Conclusion
Complications after OCC surgery are prevalent, especially regarding extensive tumors and surgery. To identify best practices in OCC surgery, hospital performance on a complicated postoperative course should be adjusted for case-mix and treatment variables. Providing feedback on hospital performance for complications can instigate improvement plans for better outcomes.
期刊介绍：
The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope.
• Broncho-esophagology
• Communicative disorders
• Head and neck surgery
• Plastic and reconstructive facial surgery
• Oncology
• Speech and hearing defects
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